Radiotherapy and Chemotherapy (non localised penile cancer)

Radiotherapy

If penile cancer has spread beyond the penis and has affected other areas of the body such as lymph nodes, a combination of both surgery to remove the lymph nodes followed by external beam radiotherapy and/or chemotherapy may be recommended.
Radiotherapy and chemotherapy can also be used independently in cases of more advanced penile cancer.

External beam radiotherapy

External beam radiotherapy (radiotherapy from outside the body) directs radiation at the cancer. It can also shrink areas of cancer which are affecting specific areas of the body and help provide relief from symptoms such as pain or discomfort.

Common side effects of radiotherapy

Fatigue

This may be caused by a combination of both treatment and travel. Getting small restful naps or taking a prescribed mild sedative medication may help.

Skin reactions

Radiotherapy can sometimes irritate the sensitive skin around the penis delaying the healing process. Vitamin E supplements and
topical creams can aid the healing process and these may be prescribed by the healthcare team. It is also advisable to keep areas that have been exposed to radiotherapy covered and protected from direct sunlight.

For more information on the possible side effects of radiotherapy in general from NHS Choices, please click here

Lymphoedema

Lymphoedema occurs when lymph fluid (which flows around the body in one direction) accumulates in the groin area and prevents
adequate drainage to the lower extremities (usually the legs). This in turn can cause the leg(s) to swell. It can sometimes also affect the
penis and scrotum. Lymphoedema is treated by a specialist team of healthcare professionals who may perform a gentle massage of the
surrounding lymph nodes in the groin or abdomen to help promote a normal flow of lymph fluid and may be used in conjunction with the application of special surgical support dressings. Treatment may take several months.

What are Lymph Nodes?

The human body is covered by a special type of drainage system called the lymphatic drainage system (see diagram). This system is
responsible for transporting excess fluid from the organs and tissues of the body in a fluid called lymph. Lymph fluid will contain various
types of cells and substances that are no longer needed. The fluid will be transported through the lymphatic drainage system and pass through small nodules or nodes that act as filters responsible for removing them. Cancerous cells which break off from an organ which has cancer can also travel along this route and become trapped at the lymph nodes where they can then accumulate and affect a new area of the body.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. This type of chemotherapy is administered directly into the blood stream and is called systemic chemotherapy. Possible chemotherapy drugs that may be used are Cisplatin, 5- Fluorouracil (infusion) and Docataxel. They will usually be administered in “cycles”. Cycles are patterns of administering certain drugs over a period of days which is then repeated over a period of weeks or months. Like all medical treatments chemotherapy can have side effects. These will differ from individual to individual and not everyone will experience the same symptoms.

For more information in general on chemotherapy from NHS Choices, please click here

Chemotherapy effects

While chemotherapy drugs are treating cancer cells they may temporarily reduce the number of normal healthy blood cells. When these become reduced men may be more at risk of infection and will tire easily. It is important to let the specialist team know if they begin to feel unwell or develop a temperature at any time during treatment. While men are receiving chemotherapy, blood tests will be taken on a regular basis to monitor the bodies general health. Before starting chemotherapy men may need to have a hearing test (audiogram) as chemotherapy can affect hearing and a breathing test as some chemotherapy can reduce lung function. If necessary, antibiotics may be given to treat any infection.

For more information on managing the possible side effects of chemotherapy from NHS Choices, please click here

The effects of chemotherapy may take some time to subside after treatment. This can take a few months to a year or more. Men may feel tired or exhausted and should take this into account when considering going back to work or for a busy lifestyle

Following radiotherapy or chemotherapy treatment further scans will be performed to see how well thecancer has responded to treatment and these results will help determine whether any further treatment is needed.

Clinical Trials and current research

Clinical trials are used to try and improve ways of treating penile cancer. They are also used to look at ways of reducing possible side
effects of treatment. Men being treated for non localised penile cancer may be asked if they wish to take part in a clinical trial. If they decide they would like to take part they can still opt out of the trial in the future without affecting subsequent medical care or future treatment.
Research into newer treatments for penile cancer that are currently being investigated include:

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes or substances that make it cancerous and cause it to grow.
Treatment is experimental but involves using chemicals such as chemotherapy to target the specific cancer cells or new chemical substances to alter or kill certain areas of the cancer.

Radiosensitizers

Radiosensitizers are drugs that make tumour cells more sensitive to radiation therapy, making radiation therapy more effective.

Combination therapy

Researchers are studying whether the combination of chemotherapy and radiation therapy better reduces the risk of recurrence and/or increases survival than standard treatments.

For more information on Clinical Trials from NHS Choices please click here

Metastatic penile cancer

Cancer that has spread to other areas or organs in the body is called metastatic disease. Unfortunately although it may not be possible to cure the cancer it may be possible to regress it to some degree using radiotherapy or chemotherapy. In this situation care and treatment will be managed by a number of health professionals who will work together to give men the best possible quality of life.

For information on the type of services that may be available please click here

To read personal stories of men who have been affected and treated for penile cancer please click here